Study led by CIC Director identifies alternative treatment for mild asthma

Dr. Paul O’Byrne is a co-author on two New England Journal of Medicine (NEJM) papers that outline a new approach for asthma treatment.

“Poor adherence to asthma medications, particularly inhaled steroids as maintenance therapy, is a major problem across all severities of asthma,” observes Dr. O’Byrne in a McMaster news story.

For ongoing control of their symptoms, most individuals with mild asthma are prescribed a steroid inhaler for use twice daily, but fewer than 20% follow this routine.

Most choose, instead, to use a relief inhaler only when they have an actual asthma attack. These inhalers contain beta-agonists, which help to open airways and facilitate breathing. They “work quickly but they do not treat the underlying problem of inflammation,” notes Dr. O’Byrne.

By contrast, the new treatment tested by Dr. O’Byrne and others replaces the conventional relief inhaler with a combined-drug inhaler, one that combines a beta-agonist (formoterol) with a steroid (budesonide).

“The secret in this new approach is that it not only relieves symptoms but at the same time delivers steroids required for overall control of asthma.”

“I think this is going to actually change the way we manage asthma.”

The treatment was tested in two parallel, large international clinical trials, spanning 25 countries, both involving close to 4,000 patients with mild asthma and both running for almost three years. Dr. O’Byrne led one of these NEJM studies, and was co-author on the second, led by Dr. Eric Bateman of the University of Cape Town.

The studies found the combined inhaler, used on an as-needed basis, better for symptom control than conventional relief inhalers and more effective at reducing the risk of asthma attacks. Although regular (twice-daily) use of the steroid alone offered best overall symptom control, the as-needed use of the combined inhaler was just as effective at reducing severe asthma attacks.

“In addition, the amount of steroids used was much less when the combined inhaler was used, because the patient did not need to take it every day,” observes Dr. O’Byrne.

The results of the two studies, Dr. O’Byrne’s and Dr. Bateman’s, were published in separate articles in NEJM.

Dr. O’Byrne is a respirologist, a professor of medicine at McMaster University’s Michael G. DeGroote School of Medicine, a clinician scientist at the Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton, and Director of AllerGen’s Clinical Investigator Collaborative (CIC). He is also Dean and Vice-President of the Faculty of Health Sciences at McMaster.

Video interview with Dr. O’Byrne